Morphea is a rare condition of the skin that is characterized by painless reddish patches on the skin. These patches thicken over time and turn into areas of thick oval shaped lesions and hence also known as localized scleroderma. These lesions occur mostly on the upper abdomen, back and stomach but can also involve the face and arms.
The exact cause of morphea is not known, but it is mostly associated with an abnormal response of the immune system to an infection or repeated injury/trauma to an area.
Is Morphea An Autoimmune Disease?
There have been many theories suggesting that morphea could be an autoimmune disorder, but other factors such as environment, genetics and vascular dysfunction might also play an important role in development of morphea or localized scleroderma. The external factors leading to the formation of morphea are skin injury/trauma, radiation therapy and skin infections. The lesions formed may either be localized (circumscribed) where only one or several patches are formed, generalized involving a major portion of the body, linear where the lesions might involve the deeper layers along with the superficial ones, and pansclerotic where there is involvement of the underlying bone and skin. It can also lead to restriction of movement of joints in some cases.
It is mostly a benign condition and does not affect the life expectancy of the patient. The lesions formed on the skin resolve on their own in 3-5 years. The formation of new lesions might take place during this time but they heal with time although the skin discoloration might last longer. Linear morphea takes a longer time to heal or show improvement. In case of deep (pansclerotic) and linear morphea some morbidity can be seen in children associated with their growth restriction. Contractures of joints, variation in length of limbs, atrophy of underlying tissue can lead to severe deformity in some people. In other cases there might be weakness and stiffness of joints in people affected by deep morphea when muscle wasting is present. Since it is a poorly understood disease research is still going on to understand the causes and pathophysiology of the condition for better understanding and also for making advances in diagnosis and treatment of the diseased condition.
Treatment Of Morphea
The aim of treatment is to control the symptoms depending upon their severity and the area of the skin surface involved. It is seen that people who present with the condition in the early stages respond well to treatment rather than people who present later. People with active disease i.e., presenting under 3 months of development of inflammation has shown improvement within weeks of starting therapy with complete clearance of the lesions. Most of the time the treatment is not required since the lesions clear on their own in some time in case of uncomplicated localized condition. However, it becomes important to consult a doctor to prevent any future complications and also know if there is involvement of deeper structures.
Most cases of morphea are treated with topical corticosteroids and phototherapy under observation. People who present with deep morphea might need aggressive therapy with methotrexate and glucocorticoids that will prevent any infection from going deeper and leading to bone involvement. It prevents disfigurement, contractures of joints and impairment of function of the area involved. Mostly, it is seen in cases of active disease where the condition progresses rapidly and ends up involving a large surface area under the skin including the bone and joints. People who are under risk of developing limitation of movement should be given physical therapy to cope up and overcome the condition. Phototherapy is beneficial in patients with generalized morphea but cannot be used in cases with deep involvement of bones and tissues as the UV rays cannot reach the deeper layers of tissues. Proper counseling of the patient should be done so that they can understand the disease better and go for appropriate treatment option.